{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T03:13:08Z","timestamp":1792552388645,"version":"4.5.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0014142","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000}}],"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:p>Cystic echinococcosis (CE) is a neglected zoonotic disease that remains a public-health concern worldwide. However, poor surveillance and incomplete reporting still hinder the calculation of the CE burden. This study evaluated national hospital discharge records (HDRs) from 2015 to 2022 to update CE epidemiological situation and economic impact of human CE in Italy. We reviewed 4,293 HDRs with an echinococcosis diagnosis during 2015\u20132022. Data extracted included age, sex, residence, nationality, primary versus secondary diagnosis, treatment type, length of stay and discharge outcome. The average annual hospital prevalence was calculated per 100,000 inhabitants and direct hospital costs were derived from records of CE as the primary diagnosis. The 2015\u20132022 trend was assessed and compared to an extended data set (2001\u20132022). From 2015 to 2022, 2,663 cases were identified nationally, over half in the southern and insular regions. The national average annual hospital prevalence was 0.56 cases\/100,000 inhabitants, peaking in the islands (1.22\/100,000 inhabitants). Patients were predominantly adults (&gt;90%) and divided into the following age categories: 25\u201344 (20.4%), 45\u201364 (30.2%) and \u226565 years (41.1%); pediatric cases were rare (&lt;3%). The mean hospital stay for primary CE diagnosis was 10.6 days with elderly patients (&gt;65 years) accounting for 70% of in-hospital deaths. National direct hospital costs amounted to \u20ac10,726,413, with 56% borne by the South and Islands (South 23%, Islands 33%). A downward trend in hospitalised CE cases was observed from 2015 (326 cases) to 2022 (165 cases), with a notable decline in 2020 linked to the COVID-19 pandemic. Analysis of the longer time period (2001\u20132022) revealed 1250 fewer cases. These findings confirm CE\u2019s heterogeneous distribution, with persistent hyperendemic foci in traditional pastoral areas driving disproportionate healthcare costs. Sustained One Health surveillance, targeted regional prevention and robust national reporting are critical to further reduce CE burden in Italy.<\/jats:p>","DOI":"10.1371\/journal.pntd.0014142","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T17:40:30Z","timestamp":1774028430000},"page":"e0014142","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Geographic, demographic and economic burden of human cystic echinococcosis in Italy based on hospital discharge records (2015\u20132022)"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4462-8257","authenticated-orcid":true,"given":"Piero","family":"Bonelli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Stegel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scilla","family":"Mastrandrea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Masu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Peruzzu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cinzia","family":"Santucciu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Masala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"issue":"1","key":"pntd.0014142.ref001","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1128\/CMR.17.1.107-135.2004","article-title":"Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern","volume":"17","author":"J Eckert","year":"2004","journal-title":"Clin Microbiol Rev"},{"issue":"9392","key":"pntd.0014142.ref002","doi-asserted-by":"crossref","DOI":"10.1016\/S0140-6736(03)14573-4","article-title":"Echinococcosis","volume":"362","author":"DP McManus","year":"2003","journal-title":"Lancet"},{"issue":"10","key":"pntd.0014142.ref003","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010540","article-title":"The dual burden of animal and human zoonoses: a systematic review","volume":"16","author":"LP Noguera Z","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014142.ref004","doi-asserted-by":"crossref","DOI":"10.1016\/j.parint.2005.11.030","article-title":"Present situation of echinococcosis in the Middle East and Arabic North Africa","volume":"55","author":"SM Sadjjadi","year":"2006","journal-title":"Parasitol Int"},{"key":"pntd.0014142.ref005","first-page":"315","article-title":"Global distribution of alveolar and cystic echinococcosis","volume-title":"Advances in Parasitology","author":"P Deplazes","year":"2017"},{"issue":"3","key":"pntd.0014142.ref006","doi-asserted-by":"crossref","DOI":"10.1016\/j.jinf.2025.106445","article-title":"Past, present and future epidemiology of echinococcosis in China based on nationwide surveillance data 2004\u20132022","volume":"90","author":"X Wang","year":"2025","journal-title":"J Infect"},{"issue":"3","key":"pntd.0014142.ref007","doi-asserted-by":"crossref","DOI":"10.1016\/S1473-3099(22)00638-7","article-title":"Unveiling the incidences and trends of the neglected zoonosis cystic echinococcosis in Europe: a systematic review from the MEmE project","volume":"23","author":"A Casulli","year":"2023","journal-title":"Lancet Infect Dis"},{"issue":"8","key":"pntd.0014142.ref008","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0008519","article-title":"Epidemiological distribution of Echinococcus granulosus s.l. infection in human and domestic animal hosts in European Mediterranean and Balkan countries: a systematic review","volume":"14","author":"F Tamarozzi","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"issue":"7","key":"pntd.0014142.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0005771","article-title":"The disease burden of human cystic echinococcosis based on HDRs from 2001 to 2014 in Italy","volume":"11","author":"T Piseddu","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014142.ref010","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.actatropica.2014.08.011","article-title":"Retrospective study of human cystic echinococcosis in Italy based on the analysis of hospital discharge records between 2001 and 2012","volume":"140","author":"D Brundu","year":"2014","journal-title":"Acta Trop"},{"key":"pntd.0014142.ref011","unstructured":"NUTS - Nomenclature of territorial units for statistics - Eurostat [Internet]. 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